Incidence and management of incidental durotomy during thoracic and lumbar spine surgeries: a retrospective review in a tertiary care centre

Abstract

Background: Incidental durotomy is among the most common complications of spine surgery with reported incidence ranging from 1.7% to 16%. Various management options including primary repair, fascial or fat graft, epidural blood patch, fibrin glue sealant, etc., have been proposed. The purpose of this study is to evaluate the incidence of incidental durotomy and the efficacy of different management options during a five year period at a tertiary care center.

Methods: All patients who underwent various surgical procedures in thoracic and lumbar spine from January 2006 - December 2010 in our centre were retrospectively reviewed. Data on demographics, primary diagnosis, associated co morbidities, details of surgical procedure, training level of the operating surgeon, details of the incidental durotomy, the treatment, complications and the postoperative stay were recorded.

Results: Of 2270 patients, 1401 patients were included in the study. The incidence of incidental durotomy was 3.49% (49 patients). We found a very high incidence of 33.33% incidental durotomies among patients who underwent revision procedures as compared to 3.23% for patients who underwent primary surgeries. 5.10% of incidental durotomies were caused by fellows under training, 4.27% by junior consultants and 2.92% by senior consultants. Of 49 durotomies, complication were 5 cases of intracranial hypotension, 5 postoperative neurological deficits, 2 deep wound infection, 2 pseudomeningocele and 1 meningitis.

Conclusions: The risk of incidental durotomy in thoracolumbar surgeries is high in revision surgeries and when performed by fellows in training. Intraoperative identification and primary repair with suturing or sealant reduces postoperative complications.